Parent-therapist therapeutic alliance - a neglected factor in pediatric speech-language intervention: A longitudinal study

Background: The therapeutic alliance (TA) has been widely used to explain variations in psychotherapy, but its role in pediatric speech-language therapy remains underexplored. Aims: This longitudinal study examined whether the TA between speech-language therapists (SLTs) and parents of children undergoing speech-language intervention predicted therapeutic outcomes and whether it moderated the effects of parental psychological factors. Methods: Forty-one parents of children aged 3–12 years and 12 SLTs participated in a 12-week intervention. SLTs rated child disorder severity at onset, TA after two sessions, and therapeutic outcomes at completion. At the onset of therapy, parents completed measures of caregiving style, perceptions of their child, and child-related emotions. Hierarchical regression models assessed predictors of therapeutic outcomes, and moderation analyses tested interactions between TA and parental variables. Results: Background variables explained 18% of the variance in therapeutic outcomes. Adding parental psychological variables increased the explained variance to 40%, and including TA significantly increased it to 50%. Stronger TA predicted better therapeutic outcomes, while greater disorder severity, compulsive caregiving, and highly positive parental perceptions of the child predicted poorer outcomes. Importantly, the moderation analysis indicated that a strong TA buffered the negative impact of compulsive caregiving on therapeutic outcomes. Conclusions: Findings underscore the role of early parent-SLT alliance in promoting therapeutic success and mitigating the negative effects of intrusive parenting. Clinicians should prioritize building a strong TA with parents and address parental psychological factors as part of pediatric speech-language therapy. Future research should include parent-reported alliance and independent outcome measures, in longitudinal multi-informant designs.